Tuesday, March 31, 2020
Lawmakers returning to Frankfort to pass a budget and other bills; here are some health-related measures that could pass
By Melissa Patrick
Kentucky Health News
As lawmakers head back to Frankfort to pass a budget -- and other bills, despite Gov. Andy Beshear's repeated request that they pass only a budget and anything related to the coronavirus -- several big bills related to other aspects of health are pending, including some controversial measures.
Beshear, a Democrat, denied the request of the Republican legislative majority to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. The lawmakers plan to pass the budget and other bills Wednesday, April 1, and return April 14 to reconsider vetoed bills.
One big health-related bill that is expected to pass is House Bill 32, sponsored by Rep. Jerry Miller, R-Louisville, to tax electronic cigarettes. This bill has been promoted as a way to reduce teen use of the products by increasing their price and to bring state government more money -- an increased concern in light of the pandemic, which is expected to cause a recession and a drop in state revenue.
HB 32 was trimmed down in a Senate committee to place a 15 percent wholesale tax on e-cig products and a $1.50 per-pod tax on Juul-type products, which is expected to bring in $25 million a year. The original bill was estimated to bring in $50 million, and that could be trimmed down even further, as two Senate floor amendments have been filed to decrease the tax to 10%.
The original version would have put a 25% tax on e-cig products, while raising the tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigs to the list. It would have also doubled the per-unit tax on chewable and non-smokable products, but did not touch the tax on traditional cigarettes.
Another health-related bill to watch is one that has been touted in the House as part of a three-phase approach to create a sustainable solution to local health departments' pension-driven financial woes.
House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move health departments, regional universities and quasi-governmental agencies away from a "percentage of pay" pension formula to a model that requires them to pay only what they owe the system over a certain period, called "level-dollar funding." This bill as written has had two readings in the Senate and resides in the Senate State & Local Government Committee.
That said, the House has filed a committee substitute to SB 249, sponsored by Sen. Chris McDaniel, R-Taylor Mill, to reflect most of the language in HB 171, with a change to include a new 30-year-amortization period for the state pension debt, rather than the 27 years in HB 171. It also adds a layered 20 year closed amortization period for any future annual increases or decreases in actuarially accrued liabilities after the 2019 valuation. SB 249 has received two readings in the House, but is not yet listed on the orders of the day. DuPlessis has said negotiations for this bill will likely be done through SB 249.
Another big health-related bill to watch is HB 387, sponsored by Rep. Danny Bentley, R-Russell, which would create a revolving loan fund for financially distressed rural hospitals.
This bill would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available. This bill has had two readings and currently resides in the Senate Appropriations & Revenue Committee.
Another important health-related bill would cap the monthly cost of insulin for many Kentuckians at $100. HB 12, sponsored by Bentley,would require state-regulated health-insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." It does not include Medicaid, Medicare or self-insured government plans.
The Senate added a committee substitute to HB 12 which would also establish an insulin assistance program. This language comes from SB 23, sponsored by Sen. Phillip Wheeler, R-Pikeville. HB 12 has had two readings and now resides in the Senate Rules Committee.
It is likely that at least one of the anti-abortion bills will move as it has been posted for some time in the House orders of the day for final passage. Senate Bill 9, sponsored by Sen. Whitney Westerfield, R-Hopkinsville, would require health-care providers to give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make not doing so a felony. The bill has been amended to remove any reference to research, so it would not inhibit ongoing research.
Critics of this bill say there are already laws in Kentucky to prevent this from happening and that the bill does not account for palliative care when infants will not live or will not have quality of life.
Another abortion bill that could pass is House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, which would expand the power of the attorney general to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations. The Senate Judiciary Committee added authority for attorney general to block abortions under gubernatorial emergency orders.
Sen. Ralph Alvarado,R-Winchester, has filed a floor amendment to ban abortion from being deemed an urgent procedure allowed during the state of emergency declared in response to covid-19 and Sen. Morgan McGarvey, D-Loisville, has filed one to allow abortions in the case of a nonviable fetus, rape, incest, or threat to the mother's life. HB 451 has had one reading in the Senate.
Another one to watch is House Bill 67, sponsored by Rep. Joseph Fischer, R-Fort Thomas, which would ban abortions if Roe v. Wade is overturned. It would have the constitution say, "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion." This bill is not as far along in the process as HB 451, but could move with a committement from the Senate to do so. It now resides in the Senate State & Local Government Committee.
Here are some other health-related bills that could pass:
HB 29, sponsored by Rep. Steve Riley, R- Glasgow, would extend temporary license for long-term care administrators to nine months, not six. It awaits concurrence in the House with a Senate committee substitute that would prohibit certification or renewal of an assisted-living community if it is owned, manged or operated by a person who has been convicted of certain crimes, it also change the appeals and renewal processes.
HB 46 , sponsored by Rep. Jerry Miller, R-Louisville, would allow full-time employees of the Commonwealth of Kentucky a paid leave of absence of 240 hours for donating a human organ and 40 hours for donating bone marrow. This bill is on the Senate consent calendar.
HB 8, sponsored by Rep. Rob Rothenburger, R-Shelbyville, would boost Medicaid reimbursements for ambulance services by setting up a trust fund to allow them to draw a federal match. This bill is on the Senate consent calendar.
HB 386, sponsored by Rep. Scott Lewis, R-Hartford, would increase from one to four years the time that local governments may contract for ambulance services. This bill is in the Senate State and Local Government Committee.
SB 20, sponsored by Sen. Danny Carroll, R-Paducah, would ban ownership or operation of assisted-living facility by, or its employment of, any person convicted of certain felonies or listed on abuse list. Bill has been reasigned to House Licensing, Occupations & Administrative Regulations Committee and has been posed for a hearing.
SB 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would limit the number of managed care organizations to three, from the current five. This bill has been returned to the House Health and Family Services with one reading.
SB 237 , sponsored by Sen. Max Wise, R-Campbellsville, would allow for the collection of tissue samples from post-mortem exams of children who have died from Sudden Infant Death Syndrome to be used for research purposes, with a parents permission. This bill is in the House Health and Family Services Committee, with one reading/
Kentucky Health News
As lawmakers head back to Frankfort to pass a budget -- and other bills, despite Gov. Andy Beshear's repeated request that they pass only a budget and anything related to the coronavirus -- several big bills related to other aspects of health are pending, including some controversial measures.
Beshear, a Democrat, denied the request of the Republican legislative majority to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. The lawmakers plan to pass the budget and other bills Wednesday, April 1, and return April 14 to reconsider vetoed bills.
One big health-related bill that is expected to pass is House Bill 32, sponsored by Rep. Jerry Miller, R-Louisville, to tax electronic cigarettes. This bill has been promoted as a way to reduce teen use of the products by increasing their price and to bring state government more money -- an increased concern in light of the pandemic, which is expected to cause a recession and a drop in state revenue.
HB 32 was trimmed down in a Senate committee to place a 15 percent wholesale tax on e-cig products and a $1.50 per-pod tax on Juul-type products, which is expected to bring in $25 million a year. The original bill was estimated to bring in $50 million, and that could be trimmed down even further, as two Senate floor amendments have been filed to decrease the tax to 10%.
The original version would have put a 25% tax on e-cig products, while raising the tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigs to the list. It would have also doubled the per-unit tax on chewable and non-smokable products, but did not touch the tax on traditional cigarettes.
Another health-related bill to watch is one that has been touted in the House as part of a three-phase approach to create a sustainable solution to local health departments' pension-driven financial woes.
House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move health departments, regional universities and quasi-governmental agencies away from a "percentage of pay" pension formula to a model that requires them to pay only what they owe the system over a certain period, called "level-dollar funding." This bill as written has had two readings in the Senate and resides in the Senate State & Local Government Committee.
That said, the House has filed a committee substitute to SB 249, sponsored by Sen. Chris McDaniel, R-Taylor Mill, to reflect most of the language in HB 171, with a change to include a new 30-year-amortization period for the state pension debt, rather than the 27 years in HB 171. It also adds a layered 20 year closed amortization period for any future annual increases or decreases in actuarially accrued liabilities after the 2019 valuation. SB 249 has received two readings in the House, but is not yet listed on the orders of the day. DuPlessis has said negotiations for this bill will likely be done through SB 249.
Another big health-related bill to watch is HB 387, sponsored by Rep. Danny Bentley, R-Russell, which would create a revolving loan fund for financially distressed rural hospitals.
This bill would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available. This bill has had two readings and currently resides in the Senate Appropriations & Revenue Committee.
Another important health-related bill would cap the monthly cost of insulin for many Kentuckians at $100. HB 12, sponsored by Bentley,would require state-regulated health-insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." It does not include Medicaid, Medicare or self-insured government plans.
The Senate added a committee substitute to HB 12 which would also establish an insulin assistance program. This language comes from SB 23, sponsored by Sen. Phillip Wheeler, R-Pikeville. HB 12 has had two readings and now resides in the Senate Rules Committee.
It is likely that at least one of the anti-abortion bills will move as it has been posted for some time in the House orders of the day for final passage. Senate Bill 9, sponsored by Sen. Whitney Westerfield, R-Hopkinsville, would require health-care providers to give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make not doing so a felony. The bill has been amended to remove any reference to research, so it would not inhibit ongoing research.
Critics of this bill say there are already laws in Kentucky to prevent this from happening and that the bill does not account for palliative care when infants will not live or will not have quality of life.
Another abortion bill that could pass is House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, which would expand the power of the attorney general to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations. The Senate Judiciary Committee added authority for attorney general to block abortions under gubernatorial emergency orders.
Sen. Ralph Alvarado,R-Winchester, has filed a floor amendment to ban abortion from being deemed an urgent procedure allowed during the state of emergency declared in response to covid-19 and Sen. Morgan McGarvey, D-Loisville, has filed one to allow abortions in the case of a nonviable fetus, rape, incest, or threat to the mother's life. HB 451 has had one reading in the Senate.
Another one to watch is House Bill 67, sponsored by Rep. Joseph Fischer, R-Fort Thomas, which would ban abortions if Roe v. Wade is overturned. It would have the constitution say, "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion." This bill is not as far along in the process as HB 451, but could move with a committement from the Senate to do so. It now resides in the Senate State & Local Government Committee.
Here are some other health-related bills that could pass:
HB 29, sponsored by Rep. Steve Riley, R- Glasgow, would extend temporary license for long-term care administrators to nine months, not six. It awaits concurrence in the House with a Senate committee substitute that would prohibit certification or renewal of an assisted-living community if it is owned, manged or operated by a person who has been convicted of certain crimes, it also change the appeals and renewal processes.
HB 46 , sponsored by Rep. Jerry Miller, R-Louisville, would allow full-time employees of the Commonwealth of Kentucky a paid leave of absence of 240 hours for donating a human organ and 40 hours for donating bone marrow. This bill is on the Senate consent calendar.
HB 8, sponsored by Rep. Rob Rothenburger, R-Shelbyville, would boost Medicaid reimbursements for ambulance services by setting up a trust fund to allow them to draw a federal match. This bill is on the Senate consent calendar.
HB 386, sponsored by Rep. Scott Lewis, R-Hartford, would increase from one to four years the time that local governments may contract for ambulance services. This bill is in the Senate State and Local Government Committee.
SB 20, sponsored by Sen. Danny Carroll, R-Paducah, would ban ownership or operation of assisted-living facility by, or its employment of, any person convicted of certain felonies or listed on abuse list. Bill has been reasigned to House Licensing, Occupations & Administrative Regulations Committee and has been posed for a hearing.
SB 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would limit the number of managed care organizations to three, from the current five. This bill has been returned to the House Health and Family Services with one reading.
SB 237 , sponsored by Sen. Max Wise, R-Campbellsville, would allow for the collection of tissue samples from post-mortem exams of children who have died from Sudden Infant Death Syndrome to be used for research purposes, with a parents permission. This bill is in the House Health and Family Services Committee, with one reading/
Is it safe to see the pediatrician for vaccines and medical visits?
We’re tackling a few urgent questions from parents in this time of coronavirus and COVID-19. Are you wondering if babies and children should continue to have vaccines on schedule? Thinking about how to manage regular medical appointments, and which situations require in-person visits to a pediatric practice? Read on.
Should parents take babies for initial vaccines right now? What about toddlers and older children who are due for vaccines?
The answer to this question is going to depend on many factors, including what your doctor’s office is offering. As with all health care decisions, it comes down to weighing risks and benefits.
In general, we think that getting those early immunizations in for babies and toddlers — especially babies 6 months and younger — has important benefits. It helps to protect them from infections such as pneumococcus and pertussis that can be deadly, at a time when their immune system is vulnerable. At the same time, they could be vulnerable to complications of COVID-19 should their trip to the doctor expose them to the virus.
For children older than 2 years, waiting is probably fine — in most cases. For some children with special health conditions, or those who are behind on immunizations, waiting may not be a good idea.
The best thing to do is call your doctor’s office. Find out what precautions they are taking to keep children safe, and discuss your particular situation, including not only your child’s health situation, but also the prevalence of the virus in your community and whether you have or might have been exposed. Together, you can make the best decision for your child.
When you need to bring your child to the doctor, even during a COVID-19 pandemic
As we all hear from all sides every day, the best thing we can do to keep ourselves and our communities safe during the COVID-19 pandemic is to stay home. But what if your child has a doctor’s appointment?
Certainly, anything that isn’t urgent should be postponed until a safer time. This would include checkups for healthy children over 2 (many practices are postponing checkups even for younger children if they are generally healthy, so check with your doctor’s office). It also includes follow-up appointments for anything that can wait, like a follow-up of ADHD in a child that is doing well socially and academically. Your doctor’s office can give you guidance about what can wait — and when to reschedule.
Many practices are offering phone or telemedicine visits, and it’s remarkable how many things can be addressed that way. I have been doing telemedicine visits, and have been struck by how much care I can give by talking with families and patients, and seeing them over video.
What requires an in-person visit?
Some things, though, do require actual contact with the patient, including:
- Acute illness or injury that could be serious, such as a child with trouble breathing, significant pain, unusual sleepiness, a high fever that won’t come down, or a cut that may need stitches or a bone that may be broken. Call your doctor for guidance on whether to bring your child to the office or a local emergency room.
- Children who are receiving ongoing treatments for a serious medical condition such as cancer, kidney disease, or a rheumatologic disease. These might include chemotherapy, infusions of other medications, dialysis, or transfusions. Your doctor will advise you as to any changes in treatments or how they are to be given during the pandemic, but you should not skip any appointments unless your doctor tells you to do so.
- Checkups for very young children who need vaccines and to have their growth checked (check with your doctor as to their current policies and practices)
- Checkups and visits for children with certain health conditions. This might include children with breathing problems whose lungs need to be listened to, children who need vaccinations to protect their immune system, children whose blood pressure is too high, children who aren’t gaining weight, children who need stitches out or a cast off, or children with abnormal blood tests that need rechecking. If your child is being followed for a medical problem, call your doctor for advice. Together you can figure out when and how your child should be seen.
The bottom line
Talk to your doctor or their representative. So much is going to depend on not just your child’s condition, but also on how prevalent the virus is in your community, whether you have had any exposures (or possible exposures), what safeguards your doctor has put into place, and how you would get to the doctor. Every situation is a bit different, and all of us in health care are doing our best to take the best care of patients that we can during this extraordinary time.
Follow me on Twitter @drClaire
The post Is it safe to see the pediatrician for vaccines and medical visits? appeared first on Harvard Health Blog.
Covid-19 update: Louisville officials plead for social distance
- Louisville officials "continued to address community concerns about reports of large gatherings of people, the Courier Journal reports. Police Chief Steve Conrad said in a Facebook Live session that his officers spend a "great deal of time responding to situations where people are gathering" but "We cannot arrest someone for standing too close to another person — nor do we want to do that. . . . We're asking for cooperation and in some cases begging for cooperation. But at this point, we do not have the authority to make an arrest in regards to social distancing."
OK, boomer: You’re not the only one who needs testing for hepatitis C
It turns out that many more people than just boomers can benefit from testing for hepatitis C, a viral infection of the liver that often causes no symptoms. If you’re a member of the baby-boom generation (born between 1946 and 1964), your doctor may have already recommended the test. But those born before or after those years may not have known about the test unless they had a risk factor for hepatitis C, such as a history of intravenous drug use. A new guideline is changing this approach.
Why the different recommendations for baby boomers?
In 2012–2013, the CDC and the US Preventive Services Task Force (USPSTF) established guidelines that recommended all baby boomers be screened for hepatitis C. Boomers were singled out because this population had most of the undiagnosed infections.
Screening for hepatitis C is a big deal, because it’s a potentially serious and treatable infection affecting an estimated four million persons in the US and 100 million people worldwide. And, while it’s common to have it without knowing it, liver failure or liver cancer are known complications that could be prevented by screening and treatment.
Studies looking at the effectiveness of screening baby boomers have demonstrated success as well as limitations. In recent years it’s become clear that the fastest growing group of people newly infected with hepatitis C is young adults ages 20 to 39 who would be missed under previous guidelines.
Why not screen everyone?
That’s essentially what newly published guidelines recommend. They suggest that everyone ages 18 to 79 have a one-time screening blood test for the antibody to hepatitis C. This antibody indicates previous exposure to the virus and/or current infection.
All recommendations from the USPSTF are given grades based on how good the evidence is that it will be beneficial. These new guidelines were assigned a “B” grade, meaning that, based on the evidence, there was at least moderate certainty that the screening would provide significant benefit. This designation is important because it means health insurers are likely to cover its cost.
What happens after a screening test is done?
If your screening test for hepatitis C is positive, your doctor will perform a separate test to confirm the results, called polymerase chain reaction (or PCR). If that proves positive, the next steps will include:
- additional tests (such as blood tests and ultrasound) to find out if the liver has significant scarring
- eight to 12 weeks of treatment with an antiviral medication, such as ledipasvir/sofosbuvir (Harvoni), glecaprevir/pibrentasvir (Mavyret), or sofosbuvir/velpatasvir (Epclusa), with regular monitoring of virus levels in the blood
- counseling about how to avoid infecting others, since hepatitis C can spread through blood and sexual contact
- regular follow-up to confirm a cure or to detect complications such as cirrhosis or liver cancer.
Liver health is not just about hepatitis C
A healthy liver is important because it performs so many essential functions: your liver removes toxins, produces bile that aids digestion, makes blood proteins that control clotting and fight infection, and stores sugar and iron.
Hepatitis C infection is only one cause of liver disease; there are many others. While keeping your liver healthy may not be something you think about every day, these measures are worth keeping in mind:
- Prevent other viral infections. While we have no vaccine yet for hepatitis C, hepatitis A and hepatitis B can be prevented by vaccination. Other ways to reduce the risk of these viral infections include avoiding contaminated food or water (a source of hepatitis A), and not using intravenous drugs or sharing needles (risk factors for hepatitis B).
- Moderate your alcohol intake.
- Maintain a healthy weight.
- Practice safe sex, and choose your tattoo or piercing parlor carefully.
- Because many medications can affect the liver, take medications only as prescribed and let your doctor know about everything you take, including over-the-counter drugs and supplements.
The bottom line
It’ll probably take a while before the new recommendations regarding screening for hepatitis C will be implemented by doctors, because they are just now hearing about them. In the meantime, if you’ve never been screened for this infection, ask your doctor about it. If you do have this virus, it’s better to know about it sooner rather than later, so you can avoid infecting others and keep your liver healthy.
Follow me on Twitter @RobShmerling
The post OK, boomer: You’re not the only one who needs testing for hepatitis C appeared first on Harvard Health Blog.
Monday, March 30, 2020
Sen. McConnell creates Cornavirus Response Portal with guidance on provisions in the federal relief act; warning that covid-19 doesn't just affect older people
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
- "The idea that this is purely a disease that causes death to older people we need to be very, very careful with," said Dr. Mike Ryan, the World Health Organization's emergencies chief, warning that as much as 10 percent to 15% of people under 50 have moderate to severe infection and many middle-aged people spend weeks in the hospital, the Associated Press reports for Modern Healthcare. The AP reports that the Centers for Disease Control and Prevention's first snapshot of cases found 29% of infections were found in ages 20 to 44; that underlying health issues can increase the increase of infection and the severity of the disease; and that men seem more susceptible than women to covid-19.
- Louisville-based Humana Inc. announced today that it is waiving all medical costs related to the treatment of covid-19 as well as FDA-approved medications or vaccines as they become available. The agency had already pledged to cover any out-of-pocket costs for coronavirus testing. The Humana news release says, "Now, costs related to subsequent treatment for COVID-19—including inpatient hospital admissions— will be waived for enrollees of Medicare Advantage plans, fully insured commercial members, Medicare Supplement and Medicaid." The Louisville Couirier Journal reports that Cigna, American worldwide health services organization is also waiving customer co-sharing and co-payments for covid-19 treatment.
- Norton Healthcare in Louisville is reporting that 45 of its employees have tested positive for the coronavirus across five-hospital systems and that the system is now working under a "universal mask protocol" starting today, Lucas Aulbach reports for the Courier Journal.
- U.S. Senate Majority Leader Mitch McConnell has created a Coronavirus Response Portal on his website to help Kentuckians take advantage of the provisions in the federal coronavirus relief act, called the CARES Act. The portal addresses unemployment insurance, low-interest federal loans, federal taxes and relief checks, federal grants, and assistance for Kentuckians traveling or living abroad.
Have a headache? The top 7 triggers
“Headaches aren’t welcome here” — that’s the sign you have hanging on your brain’s front door, but the pain is barging right in. You can chalk it up to stress from world events or something you ate or drank, and you might be right. But there are a number of common triggers for migraines, tension headaches, or cluster headaches. The faster you identify them, the quicker you can boot headache pain off the property.
What are the triggers for your headaches?
Take note of your circumstances when a headache starts. Keep a diary to track the day, time, symptoms, and circumstances surrounding the pain (what had you eaten? where did it happen?). Common causes of headaches include the following seven triggers.
- Stress. Stress can cause tight muscles in the shoulders and neck. This often leads to a tension headache, which starts in the neck and back and works its way up to feel like a tight band around your head. “It’s believed to start in the muscles,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center. “When tension headaches become frequent, the pain in shoulder and neck muscles is felt by the brain as pain in the head.” Stress is also a common trigger for a migraine headache, which begins on one side of the head, throbs or pounds, makes you sensitive to light and sound, and can last for hours or days.
- Diet. Eating certain foods often triggers a migraine headache. Migraines may be started by just one type of food — like beans or nuts — or many foods, such as avocados, bananas, cheese, chocolate, citrus, herring, dairy products, and onions. “Processed foods with nitrites, nitrates, yellow food dyes, or monosodium glutamate can be especially problematic,” Dr. Ashina notes.
- Alcohol intake. Alcohol is a common cause of a migraine headache or a cluster headache — a stabbing pain in the eye that may last hours, go away, and come back several times per day. For some people, a few ounces of red wine are all it takes to provoke a headache, although any kind of alcohol can be a trigger. It’s not clear if the alcohol itself is to blame, or if another component in the drink causes the problem.
- Environment. “Cluster headaches seem to be seasonal and often happen in the spring or fall,” Dr. Ashina says. “It’s something in the environment, but we can’t tell exactly what it is yet.” Environmental factors such as bright light, smoke, humidity, intense scents, or cold weather are associated with migraine headaches.
- Hormones. Changes in estrogen levels are associated with migraines in women, and women suffer from migraines more often than men. Menstrual cycles may be tied to migraine in younger women. Varying estrogen levels during perimenopause can sometimes start migraines in women who never experienced them before. Estrogen therapy may also be a migraine trigger. Menopause does seem to end migraines in most women.
- Caffeine withdrawal. If you normally consume caffeine in coffee or tea, stopping intake abruptly may trigger a migraine. This may be because caffeine causes blood vessels to constrict; without caffeine, the blood vessels widen and bulge out with each heartbeat — a chief reason for the pounding pain of migraines.
- Lack of sleep. A lack of sleep is associated with migraines and tension headaches. “We don’t know why, but we do know there’s a correlation and that sleep can lead to pain relief. Sometimes people feel better after taking a nap,” Dr. Ashina says.
Next steps to avoid headaches or ease headache pain
If you can associate your headache pain with particular triggers, you can try to avoid them. If that doesn’t help, talk to your doctor. There are many prescription medications, as well as pill-free treatments (acupuncture, meditation, biofeedback, relaxation therapy) that can help reduce headache frequency.
And you’ll need to go a step further: “Make sure you get enough sleep, exercise, eat a healthy diet, limit alcohol intake, and reduce stress,” Dr. Ashina says. “Headaches are a condition of hypersensitivity, so you need balance in your system to fight triggers.”
Finding that balance may be difficult right now, with the world in turmoil. But maintaining good health, and keeping a clear head that’s free of pain, will certainly give your more focus, and maybe even more strength to get through this challenging time.
The post Have a headache? The top 7 triggers appeared first on Harvard Health Blog.
Pastor and former religion reporter writes: 'Use the brain the good Lord gave you. God is real and so are pandemics.'
This column is republished with the permission of the author and the Lexington Herald-Leader, where it originally appeared. An ordained minister for more than 30 years, Paul Prather is a columnist, author and pastor of Bethesda Church near Mount Sterling, Ky. From 1988 to 1997, he was a Herald-Leader staff writer covering primarily religion.
By Paul Prather
Dozens of people from two Kentucky congregations ended up self-quarantined this past week after they ignored Gov. Andy Beshear’s plea for churches to cancel services on March 15.
These congregations held services anyway—and it turned out that worshiping among them were people already infected with covid-19.
A Louisiana pastor was threatened with having his future church meetings broken up by the National Guard after he defied statewide orders to not meet with groups larger than 50 people. The pastor claimed the coronavirus scare was “politically motivated.”
In my own community this past week, as I drove around town, mainly from the drive-through window at my bank to the drive-through window at my pharmacy, trying to practice social distancing, I realized it was business as usual for a lot of residents.
They were piling in and out of dollar stores, the post office, groceries, gas stations, pressing in cheek to jowl, seemingly without a care.
Pandemic? What pandemic?
We humans—all kinds of us, not just religious ones—are great for convincing ourselves facts don’t apply to us, that we’re immune, that we’re different, that we’re special.
Why, we’ve got our own personal Big Juju working for us that nobody else has.
So, when the governor or the president or the world’s leading healthcare scientists warn there’s a contagious disease sweeping the globe, killing people like flies in Italy and Spain and already multiplying here among us, we decide, “That doesn’t apply to me. It’s not real. If it is real, God will protect me!”
But maybe God was protecting you by giving you those warnings, do you think?
I’m an ordained minister of the gospel. I’m the epitome of what skeptics call a magical thinker.
I believe in an unseen God who created the world and ultimately controls it and is active in our lives. I believe God himself abides in my heart. I believe that on occasion he even speaks to me and perhaps acts through me.
If that’s magical thinking, count me in.
But to me there’s no conflict between being a person of faith and being a person who pays attention to actual documentable scientific facts.
There’s a virulent, life-threatening pandemic exploding. If you don’t avoid crowds and step up your hygiene and do all the rest, it’s going to sicken or possibly kill you. Or you’ll become a carrier who sickens or kills someone else.
True, even if you do what you should, it may get you anyway. But at least you can improve your odds of escaping it.
Again, it isn’t just churchgoers who live by magical thinking.
Americans of all philosophies eat triple-cheeseburgers, chain-smoke cigarettes or tailgate in the rain at 80 miles an hour while texting.
“Statistics don’t apply to me!” we cry. “I’m superman! I’ve been driving like a maniac for 30 years and ain’t had a wreck yet! I laugh at statistics!”
We conclude we’re protected by the Lord, or that rabbit’s foot in our pocket, or Mommy’s hovering ghost or genetics (“Papaw smoked 80 years and it didn’t hurt him!”).
And yes, a few people do get away with self-delusion. Papaw might have smoked like a fiend and lived to be 94.
But you probably won’t make it to 94. Papaw was what’s called a statistical outlier. By and large, though, the averages win. They come rushing back to bludgeon you into goop.
I have no inside knowledge and no crystal ball about this coronavirus. I’m not a prophet.
Plain common sense tells me covid-19 will get far worse before it gets better. I’d bet money we’ll be sheltering in place very soon. If we don’t successfully slow down the virus, our hospitals—and funeral homes—will be overrun like Italy’s.
I want to say to my friends and fellow citizens of all stripes, but especially to my fellow churchgoers: for your own sake, for all our sakes, use the brain the good Lord gave you.
Faith and common sense don’t contradict each other; they complement each other. You can trust God and acknowledge facts at the same time. God blesses us with facts.
Yes, God is real. But so are pandemics.
The Lord indeed performs miracles. I wrote a whole book about modern-day miracles. I’ve witnessed what I consider to be miracles.
God could miraculously protect you from the coronavirus. But miracles are miracles because they’re exceedingly rare. And they’re unpredictable.
Mostly, God works within the laws of nature. Christians and all other varieties of believers are subject to the same rules of biology and epidemiology as atheists.
So, it’s right and good to ask the Lord to spare you from covid-19. If you’re not religious, trust your rabbit’s foot or your good genes or your Big Juju.
But also obey public health organizations’ guidelines for protecting yourself. If the governor orders us to shelter in place, stay where you’re supposed to. Avoid groups. Wash your hands thoroughly and frequently.
Please, in this critical time, balance magical thinking with a stern dose of reality and with loving concern for the rest of us. Just do the right thing.
 |
| Paul Prather |
Dozens of people from two Kentucky congregations ended up self-quarantined this past week after they ignored Gov. Andy Beshear’s plea for churches to cancel services on March 15.
These congregations held services anyway—and it turned out that worshiping among them were people already infected with covid-19.
A Louisiana pastor was threatened with having his future church meetings broken up by the National Guard after he defied statewide orders to not meet with groups larger than 50 people. The pastor claimed the coronavirus scare was “politically motivated.”
In my own community this past week, as I drove around town, mainly from the drive-through window at my bank to the drive-through window at my pharmacy, trying to practice social distancing, I realized it was business as usual for a lot of residents.
They were piling in and out of dollar stores, the post office, groceries, gas stations, pressing in cheek to jowl, seemingly without a care.
Pandemic? What pandemic?
We humans—all kinds of us, not just religious ones—are great for convincing ourselves facts don’t apply to us, that we’re immune, that we’re different, that we’re special.
Why, we’ve got our own personal Big Juju working for us that nobody else has.
So, when the governor or the president or the world’s leading healthcare scientists warn there’s a contagious disease sweeping the globe, killing people like flies in Italy and Spain and already multiplying here among us, we decide, “That doesn’t apply to me. It’s not real. If it is real, God will protect me!”
But maybe God was protecting you by giving you those warnings, do you think?
I’m an ordained minister of the gospel. I’m the epitome of what skeptics call a magical thinker.
I believe in an unseen God who created the world and ultimately controls it and is active in our lives. I believe God himself abides in my heart. I believe that on occasion he even speaks to me and perhaps acts through me.
If that’s magical thinking, count me in.
But to me there’s no conflict between being a person of faith and being a person who pays attention to actual documentable scientific facts.
There’s a virulent, life-threatening pandemic exploding. If you don’t avoid crowds and step up your hygiene and do all the rest, it’s going to sicken or possibly kill you. Or you’ll become a carrier who sickens or kills someone else.
True, even if you do what you should, it may get you anyway. But at least you can improve your odds of escaping it.
Again, it isn’t just churchgoers who live by magical thinking.
Americans of all philosophies eat triple-cheeseburgers, chain-smoke cigarettes or tailgate in the rain at 80 miles an hour while texting.
“Statistics don’t apply to me!” we cry. “I’m superman! I’ve been driving like a maniac for 30 years and ain’t had a wreck yet! I laugh at statistics!”
We conclude we’re protected by the Lord, or that rabbit’s foot in our pocket, or Mommy’s hovering ghost or genetics (“Papaw smoked 80 years and it didn’t hurt him!”).
And yes, a few people do get away with self-delusion. Papaw might have smoked like a fiend and lived to be 94.
But you probably won’t make it to 94. Papaw was what’s called a statistical outlier. By and large, though, the averages win. They come rushing back to bludgeon you into goop.
I have no inside knowledge and no crystal ball about this coronavirus. I’m not a prophet.
Plain common sense tells me covid-19 will get far worse before it gets better. I’d bet money we’ll be sheltering in place very soon. If we don’t successfully slow down the virus, our hospitals—and funeral homes—will be overrun like Italy’s.
I want to say to my friends and fellow citizens of all stripes, but especially to my fellow churchgoers: for your own sake, for all our sakes, use the brain the good Lord gave you.
Faith and common sense don’t contradict each other; they complement each other. You can trust God and acknowledge facts at the same time. God blesses us with facts.
Yes, God is real. But so are pandemics.
The Lord indeed performs miracles. I wrote a whole book about modern-day miracles. I’ve witnessed what I consider to be miracles.
God could miraculously protect you from the coronavirus. But miracles are miracles because they’re exceedingly rare. And they’re unpredictable.
Mostly, God works within the laws of nature. Christians and all other varieties of believers are subject to the same rules of biology and epidemiology as atheists.
So, it’s right and good to ask the Lord to spare you from covid-19. If you’re not religious, trust your rabbit’s foot or your good genes or your Big Juju.
But also obey public health organizations’ guidelines for protecting yourself. If the governor orders us to shelter in place, stay where you’re supposed to. Avoid groups. Wash your hands thoroughly and frequently.
Please, in this critical time, balance magical thinking with a stern dose of reality and with loving concern for the rest of us. Just do the right thing.
Sunday, March 29, 2020
Meth returns to Appalachian Kentucky, in a more deadly form
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| Dakota Scott, with her two-week-old daughter, fights meth addiction at Karen’s Place Maternity Center in Ashland, a facility for women in addiction recovery (Photo by Hilary Swift for The New York Times) |
Officials have warned for a year or more that meth was making a comeback even as the opioid epidemic continued in Appalachia. It returned in "a powerful new form," Williams notes, and that "has brought a sharply different set of problems . . . If pain pills left residents struggling to help many family members deal with the risk of overdose, methamphetamine has bred fear and division."
Referring to homeless meth users, Louisa Mayor Harold Slone told the Times, “Half the people want to take them to the river and tie something around their neck. We hadn’t seen that level of anger before.” State police told Williams that in some places, about three-fourths of arrests are related to meth crimes — "mostly shoplifting, burglary or assault, but occasionally attempted murder."
"Opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute. A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. . . . The new Mexican variant is often mixed with cocaine, and increasingly, with fentanyl. Law-enforcement officials said cartels mix in those ingredients because fentanyl is inexpensive to produce, enhances the effects of meth and appears to cause faster addiction. Meth users around Louisa sometimes add their own dangerous ingredients, including wasp repellent, which users say produces a more intense high."
Covid-19 update
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
- The coronavirus and social distancing haven't kept many Americans from reaching out to their neighbors "with gifts, music and whatever they have to offer," The Washington Post reports.
- Republican Mitch McConnell, leader of the U.S. Senate's Republican majority, got advice from Democratic Gov. Andy Beshear in drafting the $2 trillion coronavirus rescue package, Eric Bradner reports for CNN. "It has been really helpful to get ground truth on this while developing a bill of this magnitude," Phil Maxson, McConnell's chief of staff, told Bradner.
- U.S. Reps. John Yarmuth (D-Louisville) and Andy Barr (R-Lexington) say they are leading a bipartisan effort to get the Food and Drug Administration to allow distillers to keep making hand sanitizer with their current supplies of undenatured alcohol. FDA's current guidance requires use of denatured alcohol, which has been chemically altered to be unfit for human consumption. "This will ensure distillers do not face a tax bill for filling a vital need in their communities," they wrote. The letter was signed by 87 House members, including five of the six from Kentucky; Rep. Thomas Massie was not a signatory.
Saturday, March 28, 2020
Beshear signs more than 35 bills amid pandemic, many related to health care; physician assistants get limited prescribing power
By Melissa Patrick
Kentucky Health News
The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.
“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”
Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.
Here are some of the health-related bills Beshear signed:
Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.
House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.
SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.
SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.
SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year.
SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.
SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.
SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.
HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.
Beshear had already signed several other health-related bills into law, including:
HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources. It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.
SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.
HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.
House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate.
Kentucky Health News
The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.
“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”
Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.
Here are some of the health-related bills Beshear signed:
Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.
House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.
SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.
SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.
SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year.
SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.
SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.
SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.
HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.
Beshear had already signed several other health-related bills into law, including:
HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources. It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.
SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.
HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.
House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate.
Trump declares Ky. a disaster area due to coronavirus
- President Trump declared Kentucky a major disaster area due to the coronavirus, following a request from every member of the state's congressional delegation, Senate Majority Leader Mitch McConnell announced.
- "A demand for life-saving medical gear is pitting states against one another — and the rest of the world — in a bidding war for face masks and other safety gear desperately needed to battle the virus," reports Darcy Costello of the Louisville Courier Journal.
- The 21C Museum Hotels, which started in Louisville and include one in Lexington, are closing until it is safe to reopen.
Friday, March 27, 2020
Massie, long an outlier, is a House pariah after forcing members to gather, against public-health advice, to pass virus relief bill
By Al Cross
Kentucky Health News
Thomas Massie, the congressman from Kentucky's Fourth District, has long been at the limits of elective politics at the national level. He is more Libertarian than Republican, but his strong stands against the tax-and-spend mentality of the federal government harken back to Republicans of old, such as the late Sen. Robert Taft of Cincinnati, just across the Ohio River from his district.
Now that the Republican Party has been taken over by Donald Trump and seems not to care about the nearly $24 trillion national debt and the budget deficits that build it, Massie is even more an outlier. And he made that even more so Friday, by demanding a roll-call vote on the $2 trillion coronavirus relief bill. Then Trump said he should be thrown out of the party.
Trump said on Twitter, “Looks like a third rate Grandstander named @RepThomasMassie, a Congressman from, unfortunately, a truly GREAT state, Kentucky, wants to vote against the new Save Our Workers Bill in Congress.” Trump tweeted early Friday. "Workers [and] small businesses need money now in order to survive. Virus wasn’t their fault. It is 'HELL' dealing with the Dems, had to give up some stupid things in order to get the 'big picture' done. 90% GREAT! WIN BACK HOUSE, but throw Massie out of Republican Party!”
“Mister Speaker, I came here to make sure our republic doesn't die by unanimous consent in an empty chamber, and I request a recorded vote,” he said on the floor. “I object on the basis that a quorum is not present and make a point of order that a quorum is present.”
That didn't seem to bother Massie. “The Constitution requires that a quorum of members be present to conduct business in the House. Right now, millions of essential, working-class Americans are still required to go to work during this pandemic,” he said in a long statement before his request. “Is it too much to ask that the House do its job, just like the Senate did?”
The Times reported, “Massie has never been one of the more beloved members of the House, but on Friday, he became in short order its most reviled representative, bringing together Democrats and Republicans — who had spent days fighting bitterly over the economic aid bill — around shared contempt for one man.”
Massie has a June 23 primary foe, Northern Kentucky lawyer Todd McMurtry, who says Massie hasn't voted with Trump enough. He said his foe is “a disaster for America.”
Kentucky Health News
Thomas Massie, the congressman from Kentucky's Fourth District, has long been at the limits of elective politics at the national level. He is more Libertarian than Republican, but his strong stands against the tax-and-spend mentality of the federal government harken back to Republicans of old, such as the late Sen. Robert Taft of Cincinnati, just across the Ohio River from his district.
Now that the Republican Party has been taken over by Donald Trump and seems not to care about the nearly $24 trillion national debt and the budget deficits that build it, Massie is even more an outlier. And he made that even more so Friday, by demanding a roll-call vote on the $2 trillion coronavirus relief bill. Then Trump said he should be thrown out of the party.
Trump said on Twitter, “Looks like a third rate Grandstander named @RepThomasMassie, a Congressman from, unfortunately, a truly GREAT state, Kentucky, wants to vote against the new Save Our Workers Bill in Congress.” Trump tweeted early Friday. "Workers [and] small businesses need money now in order to survive. Virus wasn’t their fault. It is 'HELL' dealing with the Dems, had to give up some stupid things in order to get the 'big picture' done. 90% GREAT! WIN BACK HOUSE, but throw Massie out of Republican Party!”
House members were in their districts, and many didn't want to return to Washington to vote, to avoid the risks of travel and gatherings; most are "older or with a pre-existing health condition," The New York Times noted. "Many were privately terrified of the health risks of traveling. So, House leaders planned to pass the bill without a roll-call vote. But Massie, 49, drove his Tesla seven hours from Lewis County to Washington to object.
“Mister Speaker, I came here to make sure our republic doesn't die by unanimous consent in an empty chamber, and I request a recorded vote,” he said on the floor. “I object on the basis that a quorum is not present and make a point of order that a quorum is present.”
The presiding officer ruled that a quorum was present, ignored Massie's request for a roll call, and the bill passed by an unrecorded voice vote. Trump signed it later in the day.
But Massie had an impact, because he had refused to say that he would not object, and that caused many of his colleagues to make unwanted trips to the Capitol, enough for a quorum, the Times reported. They were "infuriated and terrified as they put their health on the line amid a rapidly spreading pandemic to grudgingly board empty flights or drive back to the Capitol,” the Times said.
That didn't seem to bother Massie. “The Constitution requires that a quorum of members be present to conduct business in the House. Right now, millions of essential, working-class Americans are still required to go to work during this pandemic,” he said in a long statement before his request. “Is it too much to ask that the House do its job, just like the Senate did?”
The Times reported, “Massie has never been one of the more beloved members of the House, but on Friday, he became in short order its most reviled representative, bringing together Democrats and Republicans — who had spent days fighting bitterly over the economic aid bill — around shared contempt for one man.”
Massie even put Trump on the same page with former Secretary of State John Kerry, who was a U.S. senator when he was the Democratic nominee for president in 2004. He quipped that "Massie “has tested positive for being an asshole,” and should “be quarantined to prevent the spread of his massive stupidity.” Trump retweeted, “Never knew John Kerry had such a good sense of humor!” Very impressed!”
But Massie has been re-elected three times, and has his admirers. "His unwillingness to bend on even the smallest issue has charmed a slew of powerful conservative groups, including the Club for Growth and FreedomWorks," the Times notes. "His closest friends on Capitol Hill are Representative Justin Amash, the Republican turned independent from Michigan who is also a frequent invoker of constitutional principle, and Sen. Rand Paul."
Massie has a June 23 primary foe, Northern Kentucky lawyer Todd McMurtry, who says Massie hasn't voted with Trump enough. He said his foe is “a disaster for America.”
Two more Ky. deaths from covid-19, first day with more than one; Trump invokes Defense Production Act to get more ventilators
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| Ideas by Jason and Brooke Ison and @tizbitz, design by @SinclairArt for KyforKy.com |
- Gov. Andy Beshear announced two more deaths in Kentucky from covid-19, marking the first time two have been reported in one day. He said it would happen again, and more than once.
- Invoking the Defense Production Act for the first time, President Trump ordered General Motors to start producing ventilators, which hospitals say are in short supply with the number of severe covid-19 cases increasing.
- Trump named a national coordinator for production of health-care equipment, Peter Navarro, who said at Trump's daily press conference, "We are engaged in the most serious industrial mobilization since World War II."
- The Kentucky Center for Investigative Reporting gives details on the amount of personal protective equipment the federal government has shipped to Kentucky, and says "It's not enough."
- Appalachian Regional Healthcare, the largest hospital chain in Eastern Kentucky, said it would lay off about 500 employees after a 30 percent decrease in business following the ban on "non-urgent, in-person" medical procedures.
- Attorney General Daniel Cameron, who was elected on an anti-abortion platform, asked Beshear's Cabinet for Health and Family Services to temporarily ban abortion under the governor's order. Fellow Republicans in the legislature are moving a bill that would allow Cameron to do that, but they would have to take unusual steps to get it passed before the legislative session ends.
- Public art displays in Louisville, the city most pivotal in his narrow election victory in November, support Beshear, the Courier Journal reports.
- The University of Kentucky said six UK HealthCare workers, one other employee and two students have tested positive for the coronavirus.
Legislature passes bill to support state response to covid-19; includes many suspensions and changes in health-care rules
By Melissa Patrick
Kentucky Health News
FRANKFORT, Ky. -- A bill supporting and enhancing Gov. Andy Beshear's executive orders to address the coronavirus pandemic passed without dissent in both chambers of the legislature Thursday, with a caution that more measures will likely be needed.
"Things evolve as we know day to day on this issue, and I'm sure there will be more needs," Sen. Ralph Alvarado, R-Winchester, said in describing the bill. Senate President Robert Stivers told Kentucky Health News that this is likely the first step of many to address this issue, and Senate Democratic Leader Morgan McGarvey of Louisville, said, "This a good bill and it's a good start."
Senate Bill 150, generally called the "Covid-19 relief bill," was gutted of its original language about surprise medical billing and amended to offer relief on several fronts for covid-19 response.
The bill has several health-care provisions, including one to make it easier for providers to serve patients through telehealth, including one to allow out-of-state providers to practice telehealth in Kentucky.
It also clarifies language on what is considered emergent or urgent care, stating that a health-care procedure can be performed it it meets this criteria. It also allows services like physical therapy, occupational therapy, or alcohol- and drug-abuse treatment to be administered if they are ordered by a physician licensed in Kentucky.
Those provisions are in response to Beshear's order for medical facilities and providers to cease all elective procedures as a way to keep hospital beds available and preserve personal protective equipment.
The bill also has provisions aimed at expanding the state's health-care workforce.
For example, it allows the state Board of Medical Licensure, the Board of Emergency Medical Services and the Board of Nursing to waive or modify licensure or certification requirements for health-care providers who are licensed or certified in other states to provide those services in Kentucky.
It also relaxes the scope of practice requirements to allow health-care providers to practice in all settings of care; allows physicians to supervise a larger number of other providers and to do it by telephone; allows rapid certification, licensing, re-certification or re-licensing of providers; allows medical students to care for patients under a provider's supervision; and allows reactivation of licenses for inactive and retired health-care providers so that they may render service.
The bill also provides immunity for health-care providers who render care in good faith to covid-19 patients during the state of emergency, as well as immunity for Kentucky businesses acting in good faith to make or provide personal protective equipment or personal-hygiene supplies related to covid-19, and that don't make or provide such products.
A time of crisis
The bill passed on a day that Kentucky reported 50 new cases of covid-19, its largest one-day increase so far, for a total of 248. It also came at a time that Beshear warns the public daily that the next few weeks are expected to get worse.
“The next two to possibly three weeks is gonna be absolutely critical in our battle against the coronavirus,” Beshear said at his daily press conference March 25, repeating the point several times.
The bill also provides provisions to help those who have lost their jobs or have had their hours decreased because of covid-19. It waives the seven-day waiting period for unemployment benefits, extends benefits to those who are self-employed, and allows those who were not let go, but simply had their hours cut back, to also apply.
"The number of workers who filed for unemployment jumped to 48,847 from 2,785 the week before, according to non-seasonally adjusted figures from the Labor Department," Alfred Miller reported March 26 for the Louisville Courier Journal.
Among other provisions, the bill also extends the state deadline for filing income taxes to be the same as the new federal deadline, July 15, and removes all penalties and interest that could result from such extensions; permits restaurants with a license to sell alcoholic beverages in conjunction with takeout food orders; authorizes funds to support the state's covid-19 hotline; and extends the length of time government entities have to respond to an open-records request to 10 days, from three.
The bill also:
Asked as the bill was nearing passage what he needed from it, Beshear said, "I need maximum flexibility. We are living this battle and we are fighting it day by day. I need the maximum amount of financial flexibility. I need the maximum amount of flexibility if we have to take more restrictive steps. We need the flexibility to be able to move very fast to work with local governments … and local law enforcement when needed."
The bill has an emergency clause, which means it will become law as soon as Beshear signs it.
Kentucky Health News
FRANKFORT, Ky. -- A bill supporting and enhancing Gov. Andy Beshear's executive orders to address the coronavirus pandemic passed without dissent in both chambers of the legislature Thursday, with a caution that more measures will likely be needed.
"Things evolve as we know day to day on this issue, and I'm sure there will be more needs," Sen. Ralph Alvarado, R-Winchester, said in describing the bill. Senate President Robert Stivers told Kentucky Health News that this is likely the first step of many to address this issue, and Senate Democratic Leader Morgan McGarvey of Louisville, said, "This a good bill and it's a good start."
Senate Bill 150, generally called the "Covid-19 relief bill," was gutted of its original language about surprise medical billing and amended to offer relief on several fronts for covid-19 response.
The bill has several health-care provisions, including one to make it easier for providers to serve patients through telehealth, including one to allow out-of-state providers to practice telehealth in Kentucky.
It also clarifies language on what is considered emergent or urgent care, stating that a health-care procedure can be performed it it meets this criteria. It also allows services like physical therapy, occupational therapy, or alcohol- and drug-abuse treatment to be administered if they are ordered by a physician licensed in Kentucky.
Those provisions are in response to Beshear's order for medical facilities and providers to cease all elective procedures as a way to keep hospital beds available and preserve personal protective equipment.
The bill also has provisions aimed at expanding the state's health-care workforce.
For example, it allows the state Board of Medical Licensure, the Board of Emergency Medical Services and the Board of Nursing to waive or modify licensure or certification requirements for health-care providers who are licensed or certified in other states to provide those services in Kentucky.
It also relaxes the scope of practice requirements to allow health-care providers to practice in all settings of care; allows physicians to supervise a larger number of other providers and to do it by telephone; allows rapid certification, licensing, re-certification or re-licensing of providers; allows medical students to care for patients under a provider's supervision; and allows reactivation of licenses for inactive and retired health-care providers so that they may render service.
The bill also provides immunity for health-care providers who render care in good faith to covid-19 patients during the state of emergency, as well as immunity for Kentucky businesses acting in good faith to make or provide personal protective equipment or personal-hygiene supplies related to covid-19, and that don't make or provide such products.
A time of crisis
The bill passed on a day that Kentucky reported 50 new cases of covid-19, its largest one-day increase so far, for a total of 248. It also came at a time that Beshear warns the public daily that the next few weeks are expected to get worse.
“The next two to possibly three weeks is gonna be absolutely critical in our battle against the coronavirus,” Beshear said at his daily press conference March 25, repeating the point several times.
The bill also provides provisions to help those who have lost their jobs or have had their hours decreased because of covid-19. It waives the seven-day waiting period for unemployment benefits, extends benefits to those who are self-employed, and allows those who were not let go, but simply had their hours cut back, to also apply.
"The number of workers who filed for unemployment jumped to 48,847 from 2,785 the week before, according to non-seasonally adjusted figures from the Labor Department," Alfred Miller reported March 26 for the Louisville Courier Journal.
Among other provisions, the bill also extends the state deadline for filing income taxes to be the same as the new federal deadline, July 15, and removes all penalties and interest that could result from such extensions; permits restaurants with a license to sell alcoholic beverages in conjunction with takeout food orders; authorizes funds to support the state's covid-19 hotline; and extends the length of time government entities have to respond to an open-records request to 10 days, from three.
The bill also:
- Allows the governor to direct the suspension or waiving of the collection of licensing fees, renewal fees, application fees, and other administrative requirements where they are required by the state. Licensees may continue working without interruptions, and shall be granted at least 30 days after the expiration of the state of emergency to pay any fees or complete any administrative obligation before any action is taken.
- Allows a public agency to delay on-site inspections during the emergency. Public agencies may conduct their meetings by live audio or live video teleconference, with information on how the public and media can access the meeting.
- Suspends deadlines related to land use, planning and zoning, and deadlines for code enforcement proceedings and hearings.
- Allows taxing districts to suspend or otherwise extend applicable deadlines.
- Suspends the rule that a notary certify a signature after face to contact, if they can communicate via a video teleconference in real time.
- Requires Beshear to declare when the state of emergency has ceased, and if he has not done so by the first day of the next regular legislative session, the General Assembly may make that determination.
Asked as the bill was nearing passage what he needed from it, Beshear said, "I need maximum flexibility. We are living this battle and we are fighting it day by day. I need the maximum amount of financial flexibility. I need the maximum amount of flexibility if we have to take more restrictive steps. We need the flexibility to be able to move very fast to work with local governments … and local law enforcement when needed."
The bill has an emergency clause, which means it will become law as soon as Beshear signs it.
Thinning hair in women: Why it happens and what helps
Many people think of hair loss as a male problem, but it also affects at least a third of women. But unlike men, women typically experience thinning hair without going bald, and there can be a number of different underlying causes for the problem.
“Some are associated with inflammation in the body. Some are female-pattern hair loss,” says Dr. Deborah Scott, assistant professor of dermatology at Harvard Medical School and co-director of the Hair Loss Clinic at Brigham and Women’s Hospital. But the good news is that in many cases this hair loss can be stabilized with treatment, and it may be reversible. When it’s not, there are a number of new cosmetic approaches that can help.
Understanding hair loss
The first step in dealing with thinning hair is determining what’s happening inside your body that is causing those extra strands to cling to your shoulders and your brush. Some hair loss is normal. Everyone loses hair as part of the hair’s natural growth cycle, which occurs in three stages:
- The anagen stage refers to when a hair strand is actively growing. This stage can last anywhere from two to eight years.
- The catagen stage is a short transition phase that lasts up to three weeks. At this point the hair has stopped growing and is preparing to shed.
- The telogen stage is the part of the hair cycle when the hair is expelled from the follicle (the structure that produces and holds the hair). After the hair sheds, the follicle then stays dormant, typically for around three months, before a new hair starts to sprout.
Normal hair loss is highly individual. Most people have a sense of how much hair is normal for them to lose. If you suddenly notice more hair than usual falling out, you’re shedding clumps of hair, or your hair seems to be visibly thinning, it may be a sign that something is amiss, says Dr. Scott.
Underlying causes for hair loss
Numerous problems can trigger female hair loss. Some are external, such as taking certain medications, frequently wearing hairstyles that pull the hair too tight, or even a stressful event such as surgery. In other cases, thinning hair is triggered by something going on inside the body — for instance, a thyroid problem, a shift in hormones, a recent pregnancy, or an inflammatory condition.
Hair loss may also be genetic. The most common genetic condition is known as female-pattern hair loss, or androgenic alopecia. Women with this condition might notice a widening of the part at the top of the head, often beginning when a woman is in her 40s or 50s. You might experience this if you inherit certain genes from one or both parents. Hormonal shifts that occur during menopause may also spur it.
Another trigger for hair loss in women is an inflammatory condition affecting the scalp. That might be eczema, psoriasis, or a condition called frontal fibrosing alopecia, which typically causes scarring and hair loss — sometimes permanent — at the front of the scalp above the forehead.
Other common causes of hair loss include overuse of damaging hair products, or tools such as dryers and other devices that heat the hair. Underlying illness, autoimmune conditions such as lupus, nutritional deficiencies, or hormonal imbalances may also cause hair to shed.
Medications to treat hair loss
Treatment depends on the underlying cause, says Dr. Scott. Sometimes simply addressing a medical condition prompting hair loss will be enough for the hair to regrow. In other instances, a woman might consider a medication like minoxidil (Rogaine), which helps with certain types of hair loss, or another treatment to replace or regrow lost hair.
A newer option being used to treat hair loss is platelet-rich plasma (PRP) injections. For this treatment, the doctor draws your blood, divides it into its separate components, recombines the blood fluid (plasma) with a high concentration of platelets (structures in the blood that help with clotting, among other functions), and introduces the resulting preparation back into the scalp.
“The science on this isn’t totally worked out. We still don’t completely understand the mechanism behind PRP, but growth factors contained in platelets can stimulate regeneration of hair follicles and other tissues as well,” says Dr. Scott.
In addition, low-level LED laser lights have been found to be helpful in regrowing hair in some cases. It’s likely that even more treatments will be developed in the near future.
Cosmetic options for hair loss
When medical treatments fall short, women can also consider cosmetic options to make up for lost hair, such as wearing a wig. At the other end of the spectrum is hair transplantation, a surgical procedure that moves active follicles from the back of the scalp to areas where the hair is thinning. Once transplanted, the hair grows normally.
Hair transplantation is typically performed as an outpatient surgical procedure. In appropriate patients, it can be extremely successful, but it won’t work for everyone, says Dr. Scott. One drawback is the expense: it can cost thousands of dollars and is not covered by insurance. The procedure also requires recovery time. And it may not be appropriate for women who have diffuse thinning across the whole scalp. It’s more effective in treating smaller, more defined areas of balding.
The post Thinning hair in women: Why it happens and what helps appeared first on Harvard Health Blog.
Strategies to promote better sleep in these uncertain times
These are unprecedented times. Given the real and tangible threat of the coronavirus pandemic on personal, community, and societal levels, it is normal to experience anxiety and sleep problems. Sleep is a reversible state marked by a loss of consciousness to our surroundings, and as members of the animal kingdom, our brains have evolved to respond to dangers by increasing vigilance and attention — in other words, our brains are protecting us, and by doing so it’s harder for us to ignore our surroundings.
Despite the threat of the coronavirus and its rapid and pervasive disruption to our daily lives, many of us are an in a position to control our behaviors and dampen the impact of the emerging pandemic on our sleep. Cultivating healthy sleep is important; better sleep enables us to navigate stressful times better in the short term, lowers our chance of developing persistent sleep problems in the longer term, and gives our immune system a boost.
Daytime tips to help with sleep
- Keep a consistent routine. Get up at the same time every day of the week. A regular wake time helps to set your body’s natural clock (circadian rhythm, one of the main ways our bodies regulate sleep). In addition to sleep, stick to a regular schedule for meals, exercise, and other activities. This may be a different schedule than you are used to, and that is okay. Pay attention to your body’s cues and find a rhythm that works for you and that you can maintain during this “new normal.” Make this a priority for all members of your household.
- Get morning light. Get up, get out of bed, and get some light. Light is the main controller of the natural body clock, and regular exposure to light in the morning helps to set the body’s clock each day. Natural sunlight is best, as even cloudy days provide over double the light intensity of indoor lighting. If you are living in an area with shelter-in-place, try to expose yourself to natural light by stepping outside, at a distance from others, for at least 20 minutes.
- Exercise during the day helps improve your sleep quality at night, reduces stress, and improves mood. Fit in exercise as best as you can. If you need to go outside for exercise, maintain proper social distancing at least six feet away from others. Avoid any group exercise activities, especially contact sports. Many gyms and yoga studios are now “at home” and offering virtual programs at low or no cost.
- Don’t use your bed as an escape. While the gravity of the pandemic certainly makes us all tired, try not to spend too much time in bed during the day, especially if you are having trouble sleeping at night. If you must take a nap, try to keep it short — less than 30 minutes.
- Avoid caffeine late in the day.
- Helping others may help with feelings of uncertainty or unease. Even if you do not work in an “essential” industry, your role in maintaining physical distance is critical in our fight against coronavirus. If you would like to be more actively involved in helping people, seek out ways to contribute your skills, donate money, or leverage your social capacity locally, such as providing virtual social connection to your loved ones by checking in on elderly family members or a friend, or providing in-kind donations. Doing altruistic acts may provide a sense of purpose, reduce helplessness, and alleviate some of the uncertainty contributing to sleep problems.
Nighttime tips to help with sleep
- Prepare for bedtime by having a news and electronic device blackout. Avoid the news and ALL electronics at least one hour before bedtime. Avoid the news and ALL electronics at least one hour before bedtime. (Yes, it’s so important, I am saying this twice!) The nonstop news cycle seldom provides new information in the evening hours that you can’t wait until morning to hear, and will likely stimulate your mind or incite fear, making it harder to fall and stay asleep. Remind yourself by setting a timer or putting your television on the sleep setting. Make a pact with your family members to respect these parameters.
- Cell phones, tablets, and all electronic devices make it harder for your brain to turn off, and the light (even dim light) from devices may delay the release of the hormone melatonin, interfering with your body clock. If you need something to watch to help you unwind, watching something that you find relaxing on TV from far away and outside the bedroom is likely okay for a limited time. You can also curl up with a book or listen to music.
- Minimize alcohol intake. While alcohol can help people fall asleep, it leads to more sleep problems at night.
- Set a regular bedtime. There are certain times at night that your body will be able to sleep better than others. If you feel sleepy but your brain is busy thinking, it can’t shut off and go to sleep. It may be helpful to sit down with a pen and paper in the evening and write down the things that worry you; you can review this list in the morning and attend to any important concerns. If you have a bed partner, enlist their support to helping you stick to your schedule.
- Reduce stress. The evening and bedtime hours are also a good time to perform some relaxation techniques, such as slow breathing or yoga. There are many free resources available for bedtime meditation.
- Create a comfortable sleep environment, a place that is cool, dark, and quiet.
- Don’t spend too much time in bed during the night (or the daytime). Minimize spending time in bed in which you are not sleeping. If you are having trouble going to sleep or staying asleep, don’t stay in bed for more than 20 minutes. Get out of bed and do a quiet activity — read a book, journal, or fold some laundry.
What if I am doing all these things and I still can’t sleep?
This may be a sign that you have a clinical sleep problem, such as insomnia disorder or sleep apnea. If you are doing all the right things, and still have trouble falling or staying asleep, you should discuss your sleep problems with your doctor.
What if I have been diagnosed with a sleep disorder?
If you have a history of insomnia and take sleep medications and can’t sleep, contact your doctor for medical advice, including questions about making changes in your medication. Many doctors are doing virtual visits now and they can review your current sleep problems and changes to management. You can also consider online programs for insomnia, such as Sleepio.
If you have obstructive sleep apnea you can check out the American Academy of Sleep Medicine guidelines for COVID-19 related questions.
Remember, don’t stress out about sleep
Disrupted sleep is a normal response to stress, and it is okay to have a few nights of poor sleep as you adjust to new routines and big changes to your work and personal life. But with some simple measures you can preserve your sleep and improve your well-being during these uncertain times. We can’t control what’s happening in the world right now, but we can control our behaviors and dampen the impact of the emerging pandemic on our sleep
The post Strategies to promote better sleep in these uncertain times appeared first on Harvard Health Blog.
Thursday, March 26, 2020
Most Kentuckians with Alzheimer's are over 65 and have chronic illness, putting them at greater risk of covid-19; tips for caretakers
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| UKNow photo |
The increased risk of covid-19 for people with Alzheimer's presents yet another challenge for caretakers. To help them, UK's Sanders-Brown Center on Aging offers some best practices during this outbreak.
Guidance for Caregivers:
- Wash your hands when you leave the home and when you return to the home, and frequently throughout the day.
- Clean high-use surfaces, like doorknobs, sink handles and refrigerator doors, with a solution of four teaspoons bleach to four cups of water.
- Manage your underlying chronic health conditions.
- Have both your and your care-recipient's prescriptions called into a pharmacy that can either deliver them or has a drive-through pickup window.
- Monitor yourself and your person for covid-19 symptoms, which are fever, cough and sore throat, says the release. Shortness of breath is also a symptom. Call your doctor if you have any symptoms.
- Have an alternative plan of care for your person if you would not be able to provide it.
- Make sure anyone coming into your home to help with care is adhering to all hand-washing rules and monitoring themselves for covid-19 symptoms.
- Practice social distancing and make sure you and your person are not in close contact with groups of people.
- Work from home if possible, especially if your job allows telecommuting.
- Attend your worship service online or call a member of your religious organization to worship together over the phone.
- If you must take your person shopping, seek times to shop that are set aside only for seniors. Better yet, have friends, family or neighbors pick up the items you need.
- Order takeout from restaurants that can deliver or offers curbside service and allows you to pay over the phone.
- Limit family visits, including visits with grandchildren. Connect via social media or visit outside standing six feet apart.
- Going to the park and taking walks or a drive present minimal risk.
- Stick to a routine to help keep things feel normal.
- Keep the curtains open and lights on during the day.
- Try new activities within the home, like listening to music, looking at or organizing photos, folding washcloths or putting socks together, talking about historical events, playing cards, gardening or crafting.
Other tips for caring for a person with Alzheimer's:
- Be flexible and patient.
- Avoid correcting the person.
- Help the person remain as independent as possible.
- Offer opportunities to make choices, two at the most.
- Simplify instructions.
- Establish a familiar routine.
- Provide encouragement and support.
- Help get your person started in the activity if they don’t start themselves.
Republican senators write legislation that would let GOP attorney general block abortions during Beshear's pandemic emergency
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| Attorney General Daniel Cameron |
Reacting to Democratic Gov. Andy Beshear's order that apparently lets abortions continue during the covid-19 pandemic, Republican legislators have adopted a countermeasure.
A Senate amendment to House Bill 451 Thursday would allow Republican Attorney General Daniel Cameron to close abortion clinics during the pandemic. The House-passed version of the bill would have simply allowed the attorney general to enforce abortion regulations.
The revised version would give Cameron power to enforce gubernatorial emergency orders “relating to elective medical procedures, including but not limited to abortion.” Beshear issued an order banning "non-urgent, in-person" medical procedures during the pandemic, "citing the need to conserve medical resources," notes Louisville's WFPL.
The revisions included an emergency clause, so if the legislature passes the bill, presumably over a veto by Beshear, it could create the first open conflict between him and Cameron, who succeeded him in the office.
Beshear's order said the state Cabinet for Health and Family Services would rely on the judgment of "licensed health-care professionals" in deciding whether a medical procedure should be allowed. Generally, medical professional groups do not consider abortion an elective procedure, and Kentucky law bans abortions after 20 weeks, creating urgency in some cases.
Kate Miller, advocacy director for ACLU of Kentucky, told WFPL that women seeking abortions would be in a “desperate situation” if the attorney general shut down the state’s two providers, both in Louisville. “People are in desperate situations right now and the government should never have the power to force someone to stay pregnant against their will.”
Ed Harpring, pro-life coordinator for the Catholic Archdiocese of Louisville, told the Courier Journal this week that abortion providers should suspend services during the coronavirus emergency. "It seems like they are getting a pass," he said.
Republicans have supermajorities in both houses of the General Assembly, but Beshear and others have said they need to avoid controversial legislation and limit their business to the state budget and legislation related to the pandemic, so prospects for the bill's passage are unclear.
If passed by the Senate, it would return to the House for approval of the change, and House Speaker David Osborne said Thursday that the House would not pass any anti-abortion bills that day. He said an abortion bill might come to a House vote on one of the other two or three days that the legislature plans to meet before it must adjourn April 15, but “We are dealing with things that we have to get done right now, and those are going to take priority.”
Republican officials in other states have moved to limit abortions during the pandemic. "Anti-abortion groups have asked the federal government to urge abortion providers to 'cease operations' and donate medical equipment to the coronavirus response, Ryland Barton of WFPL reports.
Asked if Cameron thinks abortions are elective procedures, his office did not answer directly, telling Barton that the bill “clarifies the law in these areas.” Cameron "campaigned heavily on the abortion issue, taking up the defense of Kentucky’s anti-abortion laws that have been challenged in federal court," Barton notes.
Coping with the coronavirus pandemic for people with anxiety disorders
These days, we all have to accept the anxiety inherent in living in the time of the coronavirus pandemic and COVID-19. If there was a way to dispel all anxious feelings, I’d tell you, but there isn’t. The one exception might be someone who could summon such a degree of denial that they carry on as if everything was normal. And that, as I’m sure you can see, would prove to be very, very unwise.
Anxiety helps us prepare to respond in a more adaptive and healthy way. Some people find it possible to tolerate some degree of discomfort and can manage their anxiety in a healthy manner. Often that’s because some people have done well under this kind of challenge already, albeit in very different contexts. Life has a way of requiring this. Yet other people — particularly people who have anxiety disorders — may understandably be having a great deal of trouble coping.
How can I cope with the coronavirus outbreak if I have a pre-existing anxiety disorder?
Anxiety disorders take many forms and affect many people. So, what happens now if you’re someone who has suffered way too much already with a pre-existing anxiety disorder? For example, perhaps you have been, or could be, diagnosed with panic disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD). Hopefully, you may find that the tips below will help you cope more successfully with what we are all facing together in these unprecedented times.
Seek support from a mental health professional
Talking to a mental health professional can bolster your ability to address present concerns, and help you clarify where your feelings are coming from, as explained below. When you’re feeling extra worried or overwhelmed, it could be that some of your feelings are from the present challenge and some are from challenges you have faced in the past.
Many psychotherapists and health plans are offering telehealth visits during this time. Ask your therapist or insurance plan if this is an option. More therapists than ever before are moving their practices online. If you search for therapists in your area, their websites may tell you whether they participate in telehealth. Additionally, some national telehealth apps offer therapy via video or audio chat.
Work toward separating out where your feelings are coming from
Doing this work can allow you to take a breath and divvy up the different emotional contributions that feed how you’re feeling.
- Try saying this, for example: “Of course, I’m more concerned than (my roommate/my friend/my family), because I’m practiced at feeling anxious or helpless.”
- The next step is to recognize that the percentage of feelings that stem from the past do not have to govern how you necessarily feel in the present. Try saying this out loud: “Well that was then, this is now.” A simple statement like this can actually open the door to some significant relief.
- Gently remind yourself of this crucial separation, cleaving the past from the present. And kindly and reassuringly remind yourself that you have the resources — both internal and external — to manage your feelings and reactions in the now. This is crucially important.
Keep providing yourself with guidance
As often as you need to hear it, tell yourself the following: “I can manage. I can practice what I know to be helpful, and I know that in managing my feelings and reactions I can seek support from a few close friends. Further, I can seek the support of a mental health professional when needed. By combining these strategies, I will be able to settle my nerves in order to be able to make healthy choices.”
This kind of mantra bears repeating over and over. This is not “fake it till you make it.” This is believing in yourself and believing in a course of action that you can set in motion. Try to believe that, together with supportive others, this self-guidance and this plan will work for you. Know that in many instances, people who have known tremendous adversity and even trauma are able to demonstrate a strength forged from those circumstances. This is entirely consistent with human abilities.
Drawing on what you’ve learned can help you cope
We are wired for fight or flight. But as a colleague of mine noted, the present situation does not require either of these. If you’re a human who’s been challenged, or somewhat disabled, by anxiety in the past, I encourage you now to draw upon what you’ve learned in terms of how you can manage successfully.
Separating out feelings from the past, reminding yourself that you have the strength and ability in the present to prevail, seeing a path forward for yourself and setting yourself upon that path is the way forward. If along that way you should stumble and fall, picture yourself as able to pick yourself back up and carry on. Reassure yourself that the basic provisions for your safety and well-being are within your power to meet. In my book, every day that you are able to do so, counts as a very good day indeed.
The post Coping with the coronavirus pandemic for people with anxiety disorders appeared first on Harvard Health Blog.
